Featured Research

Use of stricter guidelines for the use of red blood cell transfusions for patients undergoing cardiac surgery was associated similar rates of death and severe illness compared to patients who received more transfusions, according to a new study.

Share This

Use of stricter guidelines for the use of red blood cell transfusions for patients undergoing cardiac surgery was associated similar rates of death and severe illness compared to patients who received more transfusions, according to a study in the October 13 issue of JAMA.

Related Articles

Cardiac surgery is associated with a high rate of blood transfusion. The rationale for red blood cell (RBC) transfusion is based on the observation that anemia is an independent risk factor for illness and death after cardiac operations. However, transfusions have been associated with high rates of these poor outcomes in critically ill patients, and some recent studies have shown worse outcomes compared with nontransfused patients after cardiac surgery, according to background information in the article. "There is a lack of evidence regarding optimal blood transfusion practice in patients undergoing cardiac surgery," the authors write.

Ludhmila A. Hajjar, M.D., Ph.D., of the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil, and colleagues conducted the Transfusion Requirements After Cardiac Surgery (TRACS) study to examine whether a restrictive strategy of RBC transfusion was as safe as a liberal strategy in patients undergoing elective cardiac surgery. The randomized clinical trial was conducted between February 2009 and February 2010 in an intensive care unit (ICU) at a university hospital cardiac surgery referral center in Brazil and included 502 adult patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were randomly assigned to a liberal strategy of blood transfusion (to maintain a hematocrit [the volume percentage of red blood cells in whole blood] of 30 percent or greater) or to a restrictive strategy (hematocrit 24 percent or greater). The overall average hematocrit values in the ICU were 31.8 percent in the liberal-strategy group and 28.4 percent in the restrictive-strategy group.

A total of 198 of 253 patients (78 percent) in the liberal-strategy group and 118 of 249 (47 percent) in the restrictive-strategy group received a blood transfusion. The researchers found that the primary composite outcome measured at 30 days -- death from any cause, cardiogenic shock, acute respiratory distress syndrome, or acute renal injury requiring dialysis or hemofiltration during the hospital stay -- occurred in 10 percent of patients in the liberal-strategy group and in 11 percent in the restrictive-strategy group. Independent of transfusion strategy, the number of transfused red blood cell units was an independent risk factor for clinical complications or death at 30 days.

There were no significant differences in the occurrence of cardiac, respiratory, neurologic, or infectious complications, or severe bleeding requiring reoperation. There were also no differences in lengths of ICU or hospital stay.

The authors suggest that the rationale for implementing a restrictive transfusion strategy is based on many studies that have shown a lack of benefit and, at the same time, substantially increased costs and adverse effects associated with RBC transfusion, including transmission of viral and bacterial diseases and transfusion-related acute lung injury.

Editorial: Blood Transfusion as a Quality Indicator in Cardiac Surgery

In an accompanying editorial, Aryeh S. Shander, M.D., of Englewood Hospital and Medical Center, Englewood, N.J., and Lawrence T. Goodnough, M.D., of the Stanford University School of Medicine, Stanford, Calif., comment on the findings of this study.

"The study by Hajjar et al is a notable addition to the existing body of evidence on the narrow benefits of RBC transfusion and its effect on outcomes in patients without hemorrhage. These studies have suggested that reduction or avoidance of transfusion in cardiac patients is associated with improved outcomes. … the trial by Hajjar et al showed that patients undergoing cardiac surgery who received fewer RBC transfusions did as well as those transfused more liberally, with no evidence of ischemia or impaired delivery of oxygen to tissues."

More From ScienceDaily

More Health & Medicine News

Featured Research

Mar. 3, 2015 — No significant change in home habits of smokers have been observed in the aftermath of a ban on smoking in public spaces, researchers report. Greater inspiration to kick the habit likely comes from ... full story

Mar. 3, 2015 — Heart function has been associated with the development of dementia and Alzheimer's disease through a new study. Participants with decreased heart function, measured by cardiac index, were two to ... full story

Mar. 3, 2015 — Children of recently separated or divorced families are likelier to drink sugar-sweetened beverages than children in families where the parents are married, putting them at higher risk for obesity ... full story

Mar. 3, 2015 — Gastric bypass and similar stomach-shrinking surgeries are a popular option for obese patients looking to lose weight or treat type 2 diabetes. While the surgeries have been linked to a decreased ... full story

Mar. 3, 2015 — Most people consume more salt than they need and therefore have a higher risk of heart disease and stroke, which are the two leading causes of death worldwide. But a new study reveals that dietary ... full story

Mar. 3, 2015 — Twice as many children born to mothers who took antibiotics during pregnancy were diagnosed with asthma by age 3 than children born to mothers who didn’t take prenatal antibiotics, a new study has ... full story

Mar. 3, 2015 — Pediatric otolaryngologists and surgeons are concerned with parents getting the wrong message regarding the safety/desirability of letting babies and young children eat peanuts to prevent them from ... full story

Mar. 3, 2015 — Why do people shake hands? A new study suggests one of the reasons for this ancient custom may be to check out each other's odors. Even if we are not consciously aware of this, handshaking may ... full story

Featured Videos

Mom Triumphs Over Tragedy, Helps Other Families

AP (Mar. 3, 2015) — After her son, Dax, died from a rare form of leukemia, Julie Locke decided to give back to the doctors at St. Jude Children&apos;s Research Hospital who tried to save his life. She raised $1.6M to help other patients and their families. (March 3)
Video provided by AP

Woman Convicted of Poisoning Son

AP (Mar. 3, 2015) — A woman who blogged for years about her son&apos;s constant health woes was convicted Monday of poisoning him to death by force-feeding heavy concentrations of sodium through his stomach tube. (March 3)
Video provided by AP

Dec. 10, 2014 — It's a simple premise -- now backed up by more evidence than ever: 'Why give more blood to anyone if you can't show it benefits them?' Research has found that for many patients, ... full story

Apr. 1, 2014 — The fewer the red blood cell transfusions, the less likely patients were to develop infections like pneumonia, a new study has illustrated. Elderly patients undergoing hip or knee surgeries were most ... full story

Jan. 2, 2014 — Incorporating a blood conservation strategy (BCS) during aortic valve replacement (AVR) can reduce the likelihood of transfusion-related complications, as well as reduce blood-product ... full story

Dec. 15, 2011 — Patients need less blood after surgery than is widely thought. A new study comparing two plans for giving blood transfusions following surgery showed no ill effects from postponing transfusion until ... full story

ScienceDaily features breaking news and videos about the latest discoveries in health, technology, the environment, and more -- from major news services and leading universities, scientific journals, and research organizations.